Why is medicine expensive?

[dieseltaylor]

As competition among cardiac-device makers has intensified, so have questions about whether their products are being used and marketed appropriately.

In January, a study in the Journal of American Medical Association found that more than one in five patients who received cardiac defibrillators did not meet science-based criteria for getting them.

Weeks later, the Heart Rhythm Society disclosed it was assisting a U.S. Justice Department investigation of the issue.

Two of the society’s biggest funders — Boston Scientific and St. Jude Medical — have paid millions since 2009 to settle federal allegations that they improperly paid kickbacks to unidentified physicians to use their cardiac devices. Neither company admitted wrongdoing.

All part of a wider piece in Pro Republica which reveals the largesse distributed to doctors, and their professional bodies.

http://www.propublica.org/article/medical-societies-and-financial-ties-to-drug-and-device-makers-industry

For non-Americans it is a chilling thought that perhaps our health systems are being suborned by the same tactics and how we need to define what and if national health services should cover.

It also shows a system which allows those companies who pay kickbacks to buy freedom from justice. Given a person must have authorised the kickback system which is illegal somebody should be going to jail. Preferably a Board Member.

[abneo3sierra]

science based criteria for getting them means that some scientist determines whether the expense of the treatment is worth the persons life, essentially..I hope they never consider that as a high consideration..as someone whose father was kept alive by one of these machines because the doctor took a chance, (against 'science based criteria' ) and gave me 6 more years with him, I would also not want to see that doctor, or anyone else in trouble for the choice..I could not disagree with you more on this one Diesel..you should hope you never are the one being told that you cannot have a treatment because you do not fit the qualifications devised by some board of scientists.

[Stalins Organ]

That's fine if you have an infinite amount of money to spend - or if yuo are spending your own (or have insurance, etc), but for those spending taxpayer dollars in health I believe it is an entirely reasonable and indeed a necessary criteria to take into account.

[abneo3sierra]

That's fine if you have an infinite amount of money to spend - or if yuo are spending your own (or have insurance' date=' etc), but for those spending taxpayer dollars in health I believe it is an entirely reasonable and indeed a necessary criteria to take into account.[/quote']

I agree..I also note that this was what the people in the USA who were against "Obamacare" called "death panels" ie..panels that would decide if it was "worth it" essentially, to the taxpayers, to save a persons life,using criteria such as age, etc. Interestingly in THAT debate, those "nutjobs" have been proven right, as the bill actually did include this type of idea mentioned here.

[Stalins Organ]

Yep - so as I understand it, now all those people that might have gotten that healthcare get nothing at all - instead of some gtting some care, all get none.

So the "death panel" still existed, and did a much better job killing people than than "Obamacare" might have?

[abneo3sierra]

Yep - so as I understand it, now all those people that might have gotten that healthcare get nothing at all - instead of some gtting some care, all get none.

So the "death panel" still existed, and did a much better job killing people than than "Obamacare" might have?

Well, actually, it is law, so that is a moot point..I think now the original supporters are P'ed off because the thing never was about "free healthcare" as the poor sods thought it was, but rather a requirement that they BUY healthcare...pretty cruel trick on them, but I am all for it..if you can afford to drive a nice car, buy satellite television, etc, but then complain that healthcare is too high, too bad, you should buy things like insurance to take care of yourself instead of my tax dollars taking care of you lol.

[Dietrich]

What conservative pols and pundits painted as a "death panel" is actually (as per Section 1233 of H.R. 3200) an "advanced care planning consultation":

a consultation between the individual and a practitioner...regarding advance care planning... Such consultation shall include the following:

(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.

(

An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.

© An explanation by the practitioner of the role and responsibilities of a health care proxy.

(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).

(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.

(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include—

(I) the reasons why the development of such an order is beneficial to the individual and the individual’s family and the reasons why such an order should be updated periodically as the health of the individual changes;

(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and

(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decision[-]maker (also known as a health care proxy).

What's sort of ironic is that what opponents of "Obamacare" paint as "death panels" actually have been going on for years (since well before the bill) and are for the benefit of the patient. Conservatives paint a picture of someone's aged parent being brought up before a row of heartless bureaucrats to be pronounced unfit to live, but in fact the decision-making power rests solely with the individual (the patient); and if even said individual is unable to make clear the sort of care they want (or don't want) to receive, the law provides for a surrogate decision-maker (such as a relative or a close friend) to make clear the individual's prior expressed wishes.

See also:

Wikipedia: "Death panel"

Wikipedia: America's Affordable Health Choices Act of 2009—Reimbursement for counseling about living wills

NYT: "My Near Death Panel Experience" by Earl Blumenauer (the Democratic Congressman who cosponsored the provision of AAHCA in question with Republican Congressman Charles Boustany)

(For the record: I neither support nor oppose "Obamacare". I simply enjoy deconstructing fear-mongering propaganda.)

[LemoN]

Thank god I live in a country that has higher quality healthcare than the US while being free.

[JonS]

Thank god I live in a country that has higher quality healthcare than the US while being free.

That's the irony, isn't it? All those fretty bettys seeing reds everywhere they look, but all they've managed to achieve instead is the most expensive system in the world that somehow produces amongst the worst outcomes in the world. All hail the free market - pay more so you can receive less.

[abneo3sierra]

Not sure I would call it the worst in the world, kings(Thailand) come here for healthcare, not to mention politicians in the last 10 yrs, alone, from Italy, Netherlands,Canada,and Japan..just to name the ones off the top of my mind.

[abneo3sierra]

What conservative pols and pundits painted as a "death panel" is actually (as per Section 1233 of H.R. 3200) an "advanced care planning consultation":

What's sort of ironic is that what opponents of "Obamacare" paint as "death panels" actually have been going on for years (since well before the bill) and are for the benefit of the patient. Conservatives paint a picture of someone's aged parent being brought up before a row of heartless bureaucrats to be pronounced unfit to live, but in fact the decision-making power rests solely with the individual (the patient); and if even said individual is unable to make clear the sort of care they want (or don't want) to receive, the law provides for a surrogate decision-maker (such as a relative or a close friend) to make clear the individual's prior expressed wishes.

See also:

Wikipedia: "Death panel"

Wikipedia: America's Affordable Health Choices Act of 2009—Reimbursement for counseling about living wills

NYT: "My Near Death Panel Experience" by Earl Blumenauer (the Democratic Congressman who cosponsored the provision of AAHCA in question with Republican Congressman Charles Boustany)

(For the record: I neither support nor oppose "Obamacare". I simply enjoy deconstructing fear-mongering propaganda.)

See the topic to which I was referring, where Stalins Organist stated that those panels were pretty much a requirement in order to keep any type of budget in a system paid for by taxpayers..it is common sense, and I agree with him..my point was,that the only way "Obamacare" could really work,at all, would be to impose them..if you have millions of patients,and limited money(as the US government, for one, is pretty much bankrupt already) someone HAS to decide, who gets care, and who does not. Thus, the conservatives were actually correct, in pointing that out.

As for those who live in a place where the care is free..EU is also going bankrupt, in large part due to things like that..once there are many people "collecting" and few people "paying" the system collapses from the top down, besides that most doctors will not work in a system where they must spend hundreds of thousands of dollars for schooling, and then be told by the government that they cannot actually make money, which is why most of the medical profession also has issues with this.

Nevertheless, as I said, I am actually in favor, I just find it funny that most of the people in favor, were thinking they were getting free healthcare out of it, and now find that it really meant they will be forced to buy it.

[costard]

I saw somewhere that the health insurance for a family of four in New York came to $65000 a year. Given that the average wage in the US is about $32000 and the minimum wage about $17000, I can see people having difficulty affording the cover they need.

Something is definitely rotten in the system - it might be best to find the problem and fix it before the patient dies.

[JonS]

Not sure I would call it the worst in the world, kings(Thailand) come here for healthcare, not to mention politicians in the last 10 yrs, alone, from Italy, Netherlands,Canada,and Japan..just to name the ones off the top of my mind.

If you can rape an entire nation for it's wealth (see: kings, Thailand) then yes; the US is definitely the place to take yourself. However, if you're more interested about overall national health outcomes, then it's also true that yes; the US is amongst the worst in the world.

'Amongst the worst' is different to 'the worst'.

[Magpie_Oz]

See the topic to which I was referring, where Stalins Organist stated that those panels were pretty much a requirement in order to keep any type of budget in a system paid for by taxpayers..it is common sense, and I agree with him..my point was,that the only way "Obamacare" could really work,at all, would be to impose them..if you have millions of patients,and limited money(as the US government, for one, is pretty much bankrupt already) someone HAS to decide, who gets care, and who does not. Thus, the conservatives were actually correct, in pointing that out.

As for those who live in a place where the care is free..EU is also going bankrupt, in large part due to things like that..once there are many people "collecting" and few people "paying" the system collapses from the top down, besides that most doctors will not work in a system where they must spend hundreds of thousands of dollars for schooling, and then be told by the government that they cannot actually make money, which is why most of the medical profession also has issues with this.

Nevertheless, as I said, I am actually in favor, I just find it funny that most of the people in favor, were thinking they were getting free healthcare out of it, and now find that it really meant they will be forced to buy it.

It doesn't have to be that way and in fact I think in most countries that have a public health system it isn't that way.

Healthcare in Oz, anyone, anywhere, anytime, NO ONE misses out we pay a small amount of tax for it. We are not bankrupt, there is no "over sight committee"

This is one of the many reasons Australia is Number 2 on the developed nations list.

[abneo3sierra]

@JonS..I agree, my point was only that the fact wealthy people(however they got that wealth) usually will choose to come to the US for their health care, definitely means our doctors are doing something right.

@Magpie..agreed, I like your system actually, did not include it..but then again, a lot more people there seem willing to actually work and "put in" to the pot, than here, where far too much of the population seems content to sit down and collect whatever crumbs the government is able to pass out every month.

In a system where people are putting in, it CAN work, but I do not see that anywhere, with exception of your region (unsure of NZ, if they have the same)

[LemoN]

someone HAS to decide, who gets care, and who does not. Thus, the conservatives were actually correct, in pointing that out.

Actually, this is completely false. This is and has always been "Conservative Propaganda". It simply isn't true.

As for those who live in a place where the care is free..EU is also going bankrupt, in large part due to things like that..once there are many people "collecting" and few people "paying" the system collapses from the top down, besides that most doctors will not work in a system where they must spend hundreds of thousands of dollars for schooling, and then be told by the government that they cannot actually make money, which is why most of the medical profession also has issues with this.

Again, completely false.

The US government alone spends MORE money per capita for healthcare than any European country, so I can't see anyone going bankrupt over this. Healthcare is NOT the reason why some European countries have gone bankrupt.. funny enough, it isn't even debt itself, it's the credit rating of a country. Just look at Japan which has more than 100% of it's BIP in dept, a way higher percentage than either Ireland, Greece or Portugal. Heck, afaik even the US has a higher debt than the three countries. The reason why they went "bankrupt" is because the credit rating agencies dumped their credit rating, making it completely infeasible to get any credit at affordable rates. It would be nearly unthinkable that the US or Germany would have their credit rating dumped (something which the US might steer into soon, given that they got a "warning shot" by several banks) By "bankruptcy" standards every western country would be bankrupt, save for Liechtenstein, Luxembourg and some other small independent countries.

Nevertheless, as I said, I am actually in favor, I just find it funny that most of the people in favor, were thinking they were getting free healthcare out of it, and now find that it really meant they will be forced to buy it.

Shhhhh, that's what they want you to believe.

[abneo3sierra]

Lemon, again, see the discussion above it..it is the ONLY way that system can work, is if there is some "oversight" committee to avoid spending money "unnecessarily" which was the beginning topic of this post even.

As for the EU...most of the reason the credit agencies dumped the credit ratings(wandering off topic, forgive me) was because they cannot pay their bills. MOSTLY this is because of the various social programs that have been em placed there. This is why as the governments in places like Greece and France and Britain, are finally realizing this, the people are protesting against "austerity"measures, because the government FINALLY recognizes that you cannot keep handing out money to everyone,and taxing the "wealthy" to pay for it..sooner or later, those "wealthy" will not have money to employ people,and the money going into the government decreases..fewer workers, fewer jobs..then the entire thing becomes top heavy and collapses..everyone getting benefits, nobody (or, not nearly enough people) putting into the pot. Now unlike a "family budget" ..the government can go and actually print money to cover this problem up for a little while, this is the phase the US is in..but after a short time, this also devalues the worth of the currency,thus making everyone even poorer than they were,and the cycle continues...sooner or later, anyone with any economic education at all, will tell you, something has to change...these systems are not meant to do what they are doing.

[womble]

Healthcare in Oz...there is no "over sight committee"

Really? Not even an equivalent of NICE (National Institute of Clinical Excellence)? Or local bodies with the same duty? There are a lot of new treatments out there that are very expensive, with variable levels of outcome. If the pot of money were infinite, then no one would need to prioritise, but it isn't. Perhaps Oz has sufficiently good health and health funding to not need to, but that's a truly fortunate situation if it's so.

I really do not envy the clinicians who have to make the decision between extending a thousand octogenarians' lives by 6 months and improving the quality of life for half a dozen sufferers of rare cancer in their last six months.

[womble]

...the governments in places like Greece and France ... FINALLY recognizes that you cannot keep handing out money to everyone,and taxing the "wealthy" to pay for it..sooner or later, those "wealthy" will not have money to employ people...

Baloney. The wealthy are still increasing the gap between them and the moderately well-off. Mostly by squeezing more work out of the same or fewer people for the same or lesser pay. They still manage to make their profits, thank you very much. Government just isn't as good at taxing them as they area at squeezing Joe Blow who can't afford a swanky tax accountant.

[dieseltaylor]

it is the ONLY way that system can work, is if there is some "oversight" committee to avoid spending money "unnecessarily" which was the beginning topic of this post even.

I agree that is the point. However you seem to be saying it is some sort of bad thing. If you have the money you can have as much health care as you wish - even if there is a national health system. : )

What countries with national health systems need to be aware of is the self-evident truth that the medical world is adept at selling extremely expensively what could be cheaper.

Secondly that if one does not have an infinite pot of money then one needs to prioritise, and also educate the electorate what is and is not possible/included in a national health system.

Thirdly perhaps getting people to accept the fact that people do die. And there is nothing medical that is going to stop it.

We are always seeing heartfelt pleas for IVF treatment, for a drug that will mean someone gets another year or so of life for a mere £30000 p.a. . I have no problem if people wish to top up their cover, or subscribe to charities for IVF research, or some church or firm based scheme. However in my book the examples I give represent the sort of medical area which is neither urgent or mandatory and would not be value for money.

A national health system should also look and persuade people to healthy choices so that they can enjoy as much normal life as possible before old age takes the fun away.

And accepting that euthanasia as an option for people is also probably desirable to get sorted as medical advances look increasingly able to keep people alive beyond what they may wish.

[dieseltaylor]

http://www.equalitytrust.org.uk/

Shows that countries with greater equality offer better health and longer life. This effect also works in the individual US states. The book, available in the US also

The Spirit Level - Richard Wilkinson

If you check the site you will find the attacks mounted on it by people who believe, presumably, large inequality is good. The rebuttals in themselves highlight the quality of information used.

Essentially the health of society is not just down to diet but cohesiveness. Particularly interesting to us would be the information on those who belong to groups live longer, and slightly left field , heal more quickly.

It covers more than health, looking at homicide , prisons , happiness etc etc, so probably 100 + graphs in 300 pages. Some of the info is quite interesting - a baby born in the US is twice as likely to die in its first year as in Greece which spends half as much. However the book is not out and out dogmatic - it just provides lots of comparable official figures and sees how they match up.

[LemoN]

Lemon, again, see the discussion above it..it is the ONLY way that system can work, is if there is some "oversight" committee to avoid spending money "unnecessarily" which was the beginning topic of this post even.

There is one system in place that approves cures/treatments for the general public. I.E. when a bypass became feasible they looked into it and decided if the treatment is at a good enough cost/benefit ratio yet. This also adds pressure for bio-health-tech companies to bring down costs and not charge 20 grand for a simple piece of plastic (which was the case for a couple of part of artificial joints). Alternatively you can also get experimental/unconventional treatments for free if your chances of survival (or your life expectancy) with conventional treatments would be too low.

What the previous posts imply is that cases are being reviewed one by one. This is NOT the case. There won't be a gremium of doctors/bureaucrats judging if your poor old granny should get her eye surgery or get her new high-tech artificial joint.

Also, with enough money you can, of course, buy yourself even better healthcare. As is the case with everything in the world.

As for the EU...most of the reason the credit agencies dumped the credit ratings(wandering off topic, forgive me) was because they cannot pay their bills. MOSTLY this is because of the various social programs that have been em placed there.

This isn't really the case. As I already said, while debt is the primary reason why a country goes bankrupt, the immediate and primary cause is the downrating of it's credit rating.

Debt is in no 1:1 relation to bankruptcy, some countries declare bankruptcy at 50% of their BIP, some countries like Japan are at over 100% and are still going.

Also, the healthcare systems in the EU are generally quite healthy, the problem are the pension systems due to the "overaging" population since the baby-boom generation is quitting the job-market.

This is why as the governments in places like Greece and France and Britain, are finally realizing this, the people are protesting against "austerity"measures, because the government FINALLY recognizes that you cannot keep handing out money to everyone,and taxing the "wealthy" to pay for it..sooner or later, those "wealthy" will not have money to employ people,and the money going into the government decreases..fewer workers, fewer jobs..then the entire thing becomes top heavy and collapses..everyone getting benefits, nobody (or, not nearly enough people) putting into the pot. Now unlike a "family budget" ..the government can go and actually print money to cover this problem up for a little while, this is the phase the US is in..but after a short time, this also devalues the worth of the currency,thus making everyone even poorer than they were,and the cycle continues...sooner or later, anyone with any economic education at all, will tell you, something has to change...these systems are not meant to do what they are doing.

This had me lol quite hard.

Ever heard of supply and demand?

By lowering the average income of your population and having the wealthy "hoard" money (I'm aware that quite a lot of people do re-invest their money, but many billions of dollars are just doing "nothing", which is the same as having the same amount of money in the bank accounts of "poor" people) you actually vastly decrease your overall demand and therefore also the overall BIP.

[abneo3sierra]

@ Diesel..I do think it is a bad thing to have someone judge by strictly an economic, or even a scientific, gauge, whether someone else should be given the chance,whatever the odds, to fight for their life. The rest of what you said, I agree with though.

@Lemon..agree in the overall sense with what you are saying, and perhaps I misunderstand something with regard to the healthcare in EU then...

@Womble...the "class war" thing really is old lol.

[gunnergoz]

Anyone else here think that decent health care is a human right in a civilized society?

[JonS]

Anyone else here think that decent health care is a human right in a civilized society?

Yes, that group called 'the World'*.

* exception: USA